Check the check up

And lo, the government said, we must woo voters. And they had a great idea: check ups. Let’s not leave them to the private providers. Let’s put them on the NHS. Everybody loves a check up.

The Department of Health sets out its new idea in a policy paper “Putting prevention first – vascular checks: risk assessment and management”. This includes the laudable aim to prevent ‘at least’ 9,500 heart attacks and strokes in a year. It is also estimated that the program could prevent 4,000 people from developing diabetes and ‘detect at least’ 25,000 people ‘earlier’ with diabetes or kidney diseases.

I’m beginning to think that this sounds suspiciously like a screening programme. The publication goes on: the vascular risk assessment programme will enable ‘everyone between 40-74 in the population to have their vascular risk managed appropriately’. Sounds daunting. Millions of people will be need to be assessed, and an enormous amount of healthcare staff time will be diverted. In light of this, one should expect this scheme to have been tested in real world situations with real world benefits in the UK population it is targeted at. One would be interested especially in medium and long term effects. One would also hope that adverse effects and cost efficiency have been examined. Instead, most of the work examining the effects of this scheme has been done through assumptions and modelling scenarios.

Further, because most of the work is intended to be done outside of GP surgeries, medical advice is not always going to be readily available. I cannot be the first doctor to have been faced with an anxious patient concerned that a cholesterol reading performed beyond the surgery has been found to have been marginally, and inconsequentially, higher at a private providers. I would not have wasted resources in needlessly repeating a test, but this is only going to be a small part of the difficulties of this new scheme. Screening tests should be done as part of an evidence-based policy which acknowledges the possibilities of false positives, negatives, and impact of tests on peoples’ lives.

Screening tests are complicated, messy and confusing. Throwing inadequately tested tests at the problem is rarely the solution.

Margaret McCartney’s Blog

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A forum on healthcare policy and professional issues, by Glasgow-based GP and FT Weekend columnist Margaret McCartney.

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